- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $2,674.65 / $7,497.00
| Facility | | $575.00 | $2,674.65 | $7,497.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.71 / $2,427.48 / $3,607.30
| Professional | | $216.71 | $2,427.48 | $3,607.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,679.17 / $7,883.38 / $15,715.89
| Facility | | $4,679.17 | $7,883.38 | $15,715.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.55 / $2,038.97 / $3,582.81
| Professional | | $193.55 | $2,038.97 | $3,582.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.11 / $4,533.55 / $4,533.55
| Facility | | $202.11 | $4,533.55 | $4,533.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,063.23 / $6,063.23 / $6,063.23
| Facility | | $6,063.23 | $6,063.23 | $6,063.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.44 / $2,626.54 / $5,494.56
| Professional | | $263.44 | $2,626.54 | $5,494.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $1,654.92
| Facility | | $55.00 | $55.00 | $1,654.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,754.24 / $3,388.45 / $22,407.53
| Professional | | $1,754.24 | $3,388.45 | $22,407.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.21 / $968.61 / $4,342.56
| Facility | | $230.21 | $968.61 | $4,342.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.55 / $2,822.29 / $4,490.01
| Professional | | $306.55 | $2,822.29 | $4,490.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.21 / $2,170.54 / $5,642.96
| Facility | | $230.21 | $2,170.54 | $5,642.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.12 / $2,712.38 / $5,645.74
| Professional | | $268.12 | $2,712.38 | $5,645.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,669.10 / $3,859.41 / $6,013.75
| Professional | | $2,669.10 | $3,859.41 | $6,013.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,189.77 / $2,431.98 / $3,485.15
| Professional | | $2,189.77 | $2,431.98 | $3,485.15 |